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In message <[log in to unmask]>, Dr. Giuseppe Giocoli <[log in to unmask]> writes >Dear Toby, >"Vae victis!" (Woe to the conquered!) Brenno shouted at Romans, throwing >his sword onto the scales, while they weighing their tributes. >"Woe betide aliens!" I said today morning while reading your sentence: "OK, >this 30 year old medical negligence solicitor who jogs every day wants a >provate referral for exercise ECG ....". >I cannot understand which kind of person is the one you are speaking about. >Toby, you often hide crystalline concepts inside a cover of very hard >English ... Dear Giuseppe "Mea culpa..." - explanation follows: A solicitor is a lawyer - this one specialises in medical negligence so we had best be careful with him in case he takes us to court. "Provate referral" is a typo for "private referral" - that is, not within the NHS, but to a private doctor who he will pay. In the UK many patients believe that if they are prepared to pay they can get whatever treatment or tests they want (and many of them are right!). However most secondary care doctors doing private work still require a referral letter from the patient's primary care physician. The problem I am posing is: even if this person puts a lot of pressure on me to agree to this test, should I in fact do so? What are the consequences of doing an exercise ECG in this person? How will we explain them to the patient? Toby -- Toby Lipman General practitioner, Newcastle upon Tyne Northern and Yorkshire research training fellow Tel 0191-2811060 (home), 0191-2437000 (surgery) Northern and Yorkshire Evidence-Based Practice Workshops http://www.eb-practice.fsnet.co.uk/